About this template
A living will form, or advance healthcare directive, is an essential legal document that lets individuals outline their medical care preferences and appoint a healthcare agent before a crisis occurs. This document provides clear instructions for healthcare providers and family members, ensuring that personal wishes regarding life-sustaining treatment, resuscitation, and end-of-life care are fully respected.
Using Doc2Form, you can quickly convert or customize this template to gather critical information such as primary contact details, specific medical treatments to refuse, tube feeding preferences, and designated primary or successor agents. Capturing these details digitally allows families, attorneys, and medical coordinators to maintain organized, accessible records while ensuring all personal directives are clearly documented.
Whether used by legal professionals during estate planning consultations or by individuals organizing their personal affairs, this template streamlines the collection of sensitive healthcare wishes. With Doc2Form, you can easily deploy this form as a standalone digital questionnaire, ensuring that loved ones and designated agents have immediate access to vital instructions when they are needed most.
Key features
- Outline specific end-of-life medical treatments and preferences
- Designate a primary healthcare agent and successor
- Specify instructions for tube feeding and IV hydration
- Record witness and notary acknowledgment details easily
- Collect encrypted, structured responses directly in Google Sheets
Use cases
- Estate planning consultations with legal professionals
- Personal preparation of family end-of-life directives
- Medical intake record keeping for long-term care facilities
- Advance care planning discussions with healthcare providers
What this form collects
- Principal Full Name (Short answer)Enter your full legal name as it appears on official identification.
- Email Address (Short answer)Provide a reliable email address for receiving a copy of your completed directives.
- Phone Number (Short answer)Enter your primary contact phone number.
- Residential Address (Paragraph)Enter your current street address, city, state, and ZIP code.
- Primary Healthcare Agent Name (Short answer)Enter the full name of the person you designate to make medical decisions on your behalf.
- Agent Phone Number & Address (Paragraph)Provide the phone number and mailing address for your primary healthcare agent.
- Successor Healthcare Agent Full Name (Short answer)Optional: Enter the name of an alternate agent if your primary agent is unavailable.
- Successor Agent Contact Information (Paragraph)Provide the phone number and address for your successor agent.
- Tube Feeding & IV Hydration Preference (Multiple choice)Select your preference regarding artificial nutrition and hydration if you are permanently unconscious.
- Treatments Refused Under Any Circumstances (Paragraph)Describe any specific medical interventions or life-sustaining treatments you explicitly refuse.
- Near-Death Care Preferences (Paragraph)Detail your wishes for pain management and comfort care in terminal situations.
- Unacceptable Quality of Life (Paragraph)Describe conditions or circumstances you would consider an unacceptable quality of life.
- Execution Date (Date)Select the date this document is being completed.
- Witness Full Name & Contact Info (Paragraph)Provide the name, phone number, and address of your first witness.
- Notary Acknowledgment Details (Paragraph)If notarized, provide the Notary Public name, county, state, and acknowledgment date, or paste a link to the signed document copy.
FAQ
What is a living will form?
A living will form is an advance healthcare directive that describes your medical care preferences if you become unable to communicate or make decisions for yourself.
Why should I use Doc2Form for this document?
Doc2Form lets you instantly convert documents into clean, structured Google Forms, making it easy to collect and organize sensitive personal and medical instructions.
When should I create a living will?
It is best to create a living will while you are in good health and mentally competent, ensuring your wishes are documented well before any medical crisis occurs.
Can I update my living will later?
Yes, you can update your directives at any time by submitting a new form reflecting your current wishes and ensuring your healthcare proxy is informed.
What details are typically included in this form?
This form typically collects personal identification, specific treatments refused, life support preferences, organ donation wishes, and contact info for designated healthcare agents.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.